13 ms·

Efficacy of hydroxychloroquine in patients with Covid-19: a randomized trial

63 points by jaboutboul 7y ago

coding123 7y ago
So it works?
- idclip 7y ago
  It sorta works. Its not a cure, but it seems to help.
- arcticbull 7y ago
  Too small a sample size to say.
  - James_Henry 7y ago
    Could you show me the statistics/theory that show that this is too small a sample size to make meaningful decisions from?
    - arcticbull 7y ago
      Statistical significance: https://en.wikipedia.org/wiki/Statistical_significance https://en.wikipedia.org/wiki/Statistical_significance
      - James_Henry 7y ago
        So, are you trying to say that the results that the researchers say are statistically significant aren't actually statistically significant? They give their numbers in the paper and the p-values are less than everyone's favorite threshold (.05). If you are trying to say that their sample size was too small to find an effect using null hypothesis testing, then that makes no sense.
- tgv 7y ago
  It looks as if this was better executed than the earlier, criticized study, but with just 2x32 patients, we'll probably have to wait for replication. One thing that certainly should be cleared up is the age effect: they report "No difference in the age ... distribution ", but that's not enough.
erikstarck 7y ago
“ Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.”
- Dobbs 7y ago
  So hate to ask this, can you explain this for non-medical spectators? Specifically what TTCR and is "absorption of pneumonia" a good thing (e.g. the body has absorbed the pneumonia and therefore it has gone away) or a bad thing (e.g. the body has absorbed the pneumonia and therefore has "collected" more)? From Paper: TTCR: Time to clinical recovery
  - TristanDaCunha 7y ago
    In pneumonia, areas of the lungs fill with fluid. This prevents the area from filling with air, which therefore prevents the exchange of CO2 and O2 between the blood and air. I will assume that 'absorption' in this sense refers to the fluid. It's a good thing when this happens, because that that area of the lung can be accessed by air again.
  - wcoenen 7y ago
    I have a feeling that this is a mistranslation, not jargon. Other similar usage of "absorption" that I can find was also written by Chinese researchers. edit: got downvoted, so adding link to only other "absorption of pneumonia" use that I could find: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344839/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344839/ edit2: I could also find some usage of "absorption of inflammation", again also all Chinese researchers.
Gimpei 7y ago
Sample size seems small. Is this adequately powered given the effect size?
- bart_spoon 7y ago
  Power wouldn't be a concern here. Power is simply the probability that, if a statistically significant difference exists, the study correctly conclude there is a difference. Essentially, if a study comes back failing to reject the null hypothesis ("there is no benefit to hydroxychloroquine"), then you might be concerned about power ("perhaps there is a benefit and our sample size was too small to detect it"). There may be other statistical points to be raised about the results of this study, but given that the null was rejected ("there was evidence of an effect of HCQ"), power wouldn't be among them. Here the null hypothesis is that hydroxychloroquine isn't any better than not receiving anything. If the study
arcticbull 7y ago
The sample size is 62 and the mortality rates are between 0% and 7% depending primarily on age and co-morbidities. I don't think we can draw any meaningful conclusions from this other than what we already know: seems worth looking into HCQ more.
- marcosdumay 7y ago
  How does the 2 cases of collateral effects compare to the normal consequences of the drug? It is very likely that we can draw conclusions about those.
  - James_Henry 7y ago
    The side effects were a headache and a rash, neither one serious. The worrisome side effects of HCQ are also given in the paper: "Retinopathy is one of the major adverse reactions of long-term therapy with HCQ. Besides, patients with rheumatoid diseases treated with HCQ occasionally experience arrhythmias." Luckily, long-term use of the drug isn't necessary here because the immune system successfully responds with antibodies to fight of the virus, so retinopathy isn't an issue. Also, as the paper states, "Fortunately, deciding on individual treatment plans scientifically, monitoring adverse reactions timely, to avoid overdose, short-term application of HCQ is relatively safe."
    - marcosdumay 7y ago
      So, evidence is pointing that we have a drug that drastically reduces hospitalization time for the milder cases, can save some 5-10% of the grave cases and is perfectly safe as long as there is a doctor looking at the patients. That is really looking like a large win. This is one of the drugs on the large study WHO is running worldwide, and is getting a lot of attention. I'm sure we'll have strong evidence either way soon.
      - James_Henry 7y ago
        I don't know that this study is talking about reduced hospitalization times. In fact, mild cases don't end up in the hospital. However, it could be that mild cases end up turning into severe cases that need hospitalization less frequently if this treatment is used. Since hospitalization is only needed in some 20% of cases, it would probably take a larger study to meaningfully determine those effects. Of course, (and even though this probably isn't the case) if all this treatment does is make the mild and moderate cases (those without and with pneumonia and not needing supplemental oxygen) end faster, we can get to herd immunity that much quicker. And yes, people are using this drug and are going to be using this drug at an increasing rate, so we'll have plenty of evidence soon.
zimpenfish 7y ago
View from a pharma-focused organic chemist: https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials https://blogs.sciencemag.org/pipeline/archives/2020/03/31/co... TL;DR: better than the French paper but that's a low, low bar
D13Fd 7y ago
I wish the current U.S. administration hadn't tried to turn this into a partisan issue.
- Recurecur 7y ago
  It absolutely did not. The press did. The mainstream US media has become a one-sided partisan cheerleading squad for the Democrats, and most Americans are sick of it. We'll see how that works out in November.
  - starkd 7y ago
    Exactly. How is passing on information that had already been widely circulating among medical professionals making it partisan?
  - ageofwant 7y ago
    This is the one great thing about democracy: you choose exactly what you deserve.
  - philjohn 7y ago
    Let's not jump the gun yet - not even been peer-reviewed.
    - bart_spoon 7y ago
      I would argue that its being peer-reviewed as we speak. The typical peer-review process involves having other experts review the paper, for free, before publication. One small silver lining of this pandemic is the urgency has caused the scientific model to shift towards preprints, which are rapidly disseminated among the scientific community via places like Twitter and Reddit, and notable papers end up getting vetted by many, many more experts much more quickly than they would via the traditional process. I've already seen many flawed papers quickly debunked and shot down, and others quickly floated to the top of the discussion, via experts commenting on Twitter and elsewhere. I wonder if after all this is over, if our methods of modern science are changed forever, or if we just revert to where we were before.
davidw 7y ago
Seems relevant: https://twitter.com/SquawkCNBC/status/1245669685267439616 https://twitter.com/SquawkCNBC/status/1245669685267439616 Not sure they've been doing proper studies and such because they're so slammed, but it seems they've been trying it in Italy and... maybe it helps some, but doesn't seem like it works miracles.
- Recurecur 7y ago
  In combination with antibiotics and (it seems) zinc it looks quite effective. A doctor in NY has treated with that combination and is up to almost 700 COVID-19 patients without one dying _or needing a ventilator_. Some relevant quotes: >Dr. Zelenko said the whole treatment costs only $20 over a period of 5 days with 100% success. He defines success as “Not to die.” Dr. Zelenko first posted his Facebook video message last week calling on President Trump to “advise the country that they should be taking this medication.” >There are many other success stories about hydroxychloroquine across the country. Last week, Dr. William Grace, an oncologist at Lenox Hill Hospital in New York City, said they’ve not had a single death in their hospital because of hydroxychloroquine. “Thanks to hydroxychloroquine, we have not had a death in our hospital,’ Dr. Grace said. From: https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/ https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-... When people are dying in large numbers, sometimes "anecdotal evidence" (especially with large samples) is plenty.
  - scribu 7y ago
    Edit: Thanks for linking to the source Snopes has more details of side-effects etc: https://www.snopes.com/fact-check/zelenko-669-coronavirus-patients/ https://www.snopes.com/fact-check/zelenko-669-coronavirus-pa...
    - jdhn 7y ago
      Snopes has it marked as unproven, so it just means that they're waiting for more results to come in. For anybody who's interested, here's an interview with the doctor himself: https://forward.com/news/national/442285/coronavirus-hydroxychloroquine-trump-doctor/ https://forward.com/news/national/442285/coronavirus-hydroxy...
blakesterz 7y ago
I know someone with Lupus, as I'm sure many people do. This is really good news for most everyone right now. But for people who need these types of drugs to fight Lupus (and I'd assume many other diseases) this is really bittersweet because they can either not get it at all now, or only get a very small amount. It's good to see this is going to help people with Covid-19, I really hope the drug makers can get this production ramped up fast so others that need these drugs can get what they need again.
karl11 7y ago
Based on this and all the other anecdotal studies plus all the people treated with it for other ailments, it seems fairly certain that at a minimum this treatment is not causing more harm. Given that plus all the indications that it seems to help to some degree, we should be pursuing production scale of these drugs aggressively. It is very unfortunate that the media politicized this treatment in such a way that now everyone who dislikes Trump carries an initial bias against it.
- starkd 7y ago
  It's quite remarkable to see the media more focused on how they are supposed to oppose Trump rather than just reporting the news.
- VBprogrammer 7y ago
  To use a very celtic phrase, it's a shame Trump is such a gobshite he couldn't help himself but to promote this as a miracle cure before the science was settled.
- orwin 7y ago
  I'm not american and i really, really don't care about trump now (i did in 2017 when i wanted an internship in Ohio that was denied cause new policies and all that stuff but i eventually found something better, so i'm not angry about it). Antiviral drugs will always be given to late in this disease case, maybe it can reduce infectuosity but we don't know enough yet. Maybe giving it to everyone to prevent the disease before its even there could be helpfull, but if i had to take HCQ, i will have to stop taking my antihistamine drugs, and going into april/may, this is a big no for me. The fact that it can also reduce the autoimmune reaction is really interesting though, so maybe giving it to mild cases will prevent them to destroy their own cells, but this is also dangerous as the disease can cause myocard lesions (probably the autoimmune reaction, but we don't know yet). In any case, talking about it is useless before more data arrive: even if we could give HCQ to everybody, the lockdown is still necessary until the first wave decrease (at least in France). Don't forge an opinion on something this early, it will be hard to let it go if you're wrong, and being right early don't give you anything.
fb1994 7y ago
Check this out from an authority on viruses and bacteria .author of 23 books https://www.stephenharrodbuhner.com/wp-content/uploads/2020/03/coronavirus.txt.pdf https://www.stephenharrodbuhner.com/wp-content/uploads/2020/...
tangue 7y ago
I live in an island where during a viral outbreak some were advocating for chloroquine against the Chikungunya virus. The initial in-vitro tests were promising but it turns out during human trials it has a reverse effect and delayed adaptive immune responses (1). It's sad to see scientific method destroyed by politics and social networks. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977261/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977261/
- Alex3917 7y ago
  > It's sad to see scientific method destroyed by politics and social networks. If there were such a thing as phase 5 trials with at least a million participants, it would be completely insane to use anything that had only undergone phase 3 clinical trials. People should make rational decisions based on the best evidence that's available at the time. Whether or not it's rational to take HCQ, there's nothing magical about phase 3 studies. Antiviral drugs only really work in the first couple days of the illness, and with this disease you usually don't get symptoms until at least day 5. And in the current environment, no one is getting put on prescription antivirals until at least day 10, and usually even later. To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now.
  - James_Henry 7y ago
    >To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now. I don't think I understand this. We have a clinical trial with in vivo data right here though, right?
    - Alex3917 7y ago
      > We have a clinical trial with in vivo data right here though, right? AFAIK there's no clinical trial data, but there is in vivo data. My point though is that these are drugs that block viral replication, and we're mostly only administering them after the virus has already finished replicating. So in that scenario of course it's going to look ineffective regardless of whether it actually works or not. I don't believe the data showing it works, but I also don't believe the data showing it doesn't work.
aazaa 7y ago
It's worth noting that this study does not include azithromycin in the treatment regime, as was the case in the Raoult/French study. The French study, problematic in the extreme but still promising, claims a large synergistic effect of using both drugs in combination. Also, unlike the French study, this one appears to be at least controlled, but possibly not blinded.
- kiloDalton 7y ago
  I think this counts a double blind trial. From the top of page 4 in the article: "Randomization was performed through a computer-generated list stratified by site. Treatments were assigned after confirming the correctness of the admission criteria. Neither the research performers nor the patients were aware of the treatment assignments."
wavepruner 7y ago
"Key findings: For the 62 COVID-19 patients, 46.8% (29 of 62) were male and 53.2% (33 of 62) were female, the mean age was 44.7 (15.3) years. No difference in the age and sex distribution between the control group and the HCQ group. But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia."

63 points by jaboutboul 7y ago

coding123 7y ago

So it works?

idclip 7y ago
It sorta works. Its not a cure, but it seems to help.
arcticbull 7y ago
Too small a sample size to say.
- James_Henry 7y ago
  Could you show me the statistics/theory that show that this is too small a sample size to make meaningful decisions from?
  - arcticbull 7y ago
    Statistical significance: https://en.wikipedia.org/wiki/Statistical_significance https://en.wikipedia.org/wiki/Statistical_significance
    - James_Henry 7y ago
      So, are you trying to say that the results that the researchers say are statistically significant aren't actually statistically significant? They give their numbers in the paper and the p-values are less than everyone's favorite threshold (.05). If you are trying to say that their sample size was too small to find an effect using null hypothesis testing, then that makes no sense.
tgv 7y ago
It looks as if this was better executed than the earlier, criticized study, but with just 2x32 patients, we'll probably have to wait for replication. One thing that certainly should be cleared up is the age effect: they report "No difference in the age ... distribution ", but that's not enough.

erikstarck 7y ago

“ Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.”

Dobbs 7y ago
So hate to ask this, can you explain this for non-medical spectators? Specifically what TTCR and is "absorption of pneumonia" a good thing (e.g. the body has absorbed the pneumonia and therefore it has gone away) or a bad thing (e.g. the body has absorbed the pneumonia and therefore has "collected" more)? From Paper: TTCR: Time to clinical recovery
- TristanDaCunha 7y ago
  In pneumonia, areas of the lungs fill with fluid. This prevents the area from filling with air, which therefore prevents the exchange of CO2 and O2 between the blood and air. I will assume that 'absorption' in this sense refers to the fluid. It's a good thing when this happens, because that that area of the lung can be accessed by air again.
- wcoenen 7y ago
  I have a feeling that this is a mistranslation, not jargon. Other similar usage of "absorption" that I can find was also written by Chinese researchers. edit: got downvoted, so adding link to only other "absorption of pneumonia" use that I could find: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344839/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344839/ edit2: I could also find some usage of "absorption of inflammation", again also all Chinese researchers.

Gimpei 7y ago

Sample size seems small. Is this adequately powered given the effect size?

bart_spoon 7y ago
Power wouldn't be a concern here. Power is simply the probability that, if a statistically significant difference exists, the study correctly conclude there is a difference. Essentially, if a study comes back failing to reject the null hypothesis ("there is no benefit to hydroxychloroquine"), then you might be concerned about power ("perhaps there is a benefit and our sample size was too small to detect it"). There may be other statistical points to be raised about the results of this study, but given that the null was rejected ("there was evidence of an effect of HCQ"), power wouldn't be among them. Here the null hypothesis is that hydroxychloroquine isn't any better than not receiving anything. If the study

arcticbull 7y ago

The sample size is 62 and the mortality rates are between 0% and 7% depending primarily on age and co-morbidities. I don't think we can draw any meaningful conclusions from this other than what we already know: seems worth looking into HCQ more.

marcosdumay 7y ago
How does the 2 cases of collateral effects compare to the normal consequences of the drug? It is very likely that we can draw conclusions about those.
- James_Henry 7y ago
  The side effects were a headache and a rash, neither one serious. The worrisome side effects of HCQ are also given in the paper: "Retinopathy is one of the major adverse reactions of long-term therapy with HCQ. Besides, patients with rheumatoid diseases treated with HCQ occasionally experience arrhythmias." Luckily, long-term use of the drug isn't necessary here because the immune system successfully responds with antibodies to fight of the virus, so retinopathy isn't an issue. Also, as the paper states, "Fortunately, deciding on individual treatment plans scientifically, monitoring adverse reactions timely, to avoid overdose, short-term application of HCQ is relatively safe."
  - marcosdumay 7y ago
    So, evidence is pointing that we have a drug that drastically reduces hospitalization time for the milder cases, can save some 5-10% of the grave cases and is perfectly safe as long as there is a doctor looking at the patients. That is really looking like a large win. This is one of the drugs on the large study WHO is running worldwide, and is getting a lot of attention. I'm sure we'll have strong evidence either way soon.
    - James_Henry 7y ago
      I don't know that this study is talking about reduced hospitalization times. In fact, mild cases don't end up in the hospital. However, it could be that mild cases end up turning into severe cases that need hospitalization less frequently if this treatment is used. Since hospitalization is only needed in some 20% of cases, it would probably take a larger study to meaningfully determine those effects. Of course, (and even though this probably isn't the case) if all this treatment does is make the mild and moderate cases (those without and with pneumonia and not needing supplemental oxygen) end faster, we can get to herd immunity that much quicker. And yes, people are using this drug and are going to be using this drug at an increasing rate, so we'll have plenty of evidence soon.

zimpenfish 7y ago

View from a pharma-focused organic chemist: https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials https://blogs.sciencemag.org/pipeline/archives/2020/03/31/co... TL;DR: better than the French paper but that's a low, low bar

D13Fd 7y ago

I wish the current U.S. administration hadn't tried to turn this into a partisan issue.

Recurecur 7y ago
It absolutely did not. The press did. The mainstream US media has become a one-sided partisan cheerleading squad for the Democrats, and most Americans are sick of it. We'll see how that works out in November.
- starkd 7y ago
  Exactly. How is passing on information that had already been widely circulating among medical professionals making it partisan?
- ageofwant 7y ago
  This is the one great thing about democracy: you choose exactly what you deserve.
- philjohn 7y ago
  Let's not jump the gun yet - not even been peer-reviewed.
  - bart_spoon 7y ago
    I would argue that its being peer-reviewed as we speak. The typical peer-review process involves having other experts review the paper, for free, before publication. One small silver lining of this pandemic is the urgency has caused the scientific model to shift towards preprints, which are rapidly disseminated among the scientific community via places like Twitter and Reddit, and notable papers end up getting vetted by many, many more experts much more quickly than they would via the traditional process. I've already seen many flawed papers quickly debunked and shot down, and others quickly floated to the top of the discussion, via experts commenting on Twitter and elsewhere. I wonder if after all this is over, if our methods of modern science are changed forever, or if we just revert to where we were before.

davidw 7y ago

Seems relevant: https://twitter.com/SquawkCNBC/status/1245669685267439616 https://twitter.com/SquawkCNBC/status/1245669685267439616 Not sure they've been doing proper studies and such because they're so slammed, but it seems they've been trying it in Italy and... maybe it helps some, but doesn't seem like it works miracles.

Recurecur 7y ago
In combination with antibiotics and (it seems) zinc it looks quite effective. A doctor in NY has treated with that combination and is up to almost 700 COVID-19 patients without one dying _or needing a ventilator_. Some relevant quotes: >Dr. Zelenko said the whole treatment costs only $20 over a period of 5 days with 100% success. He defines success as “Not to die.” Dr. Zelenko first posted his Facebook video message last week calling on President Trump to “advise the country that they should be taking this medication.” >There are many other success stories about hydroxychloroquine across the country. Last week, Dr. William Grace, an oncologist at Lenox Hill Hospital in New York City, said they’ve not had a single death in their hospital because of hydroxychloroquine. “Thanks to hydroxychloroquine, we have not had a death in our hospital,’ Dr. Grace said. From: https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/ https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-... When people are dying in large numbers, sometimes "anecdotal evidence" (especially with large samples) is plenty.
- scribu 7y ago
  Edit: Thanks for linking to the source Snopes has more details of side-effects etc: https://www.snopes.com/fact-check/zelenko-669-coronavirus-patients/ https://www.snopes.com/fact-check/zelenko-669-coronavirus-pa...
  - jdhn 7y ago
    Snopes has it marked as unproven, so it just means that they're waiting for more results to come in. For anybody who's interested, here's an interview with the doctor himself: https://forward.com/news/national/442285/coronavirus-hydroxychloroquine-trump-doctor/ https://forward.com/news/national/442285/coronavirus-hydroxy...

blakesterz 7y ago

I know someone with Lupus, as I'm sure many people do. This is really good news for most everyone right now. But for people who need these types of drugs to fight Lupus (and I'd assume many other diseases) this is really bittersweet because they can either not get it at all now, or only get a very small amount. It's good to see this is going to help people with Covid-19, I really hope the drug makers can get this production ramped up fast so others that need these drugs can get what they need again.

karl11 7y ago

Based on this and all the other anecdotal studies plus all the people treated with it for other ailments, it seems fairly certain that at a minimum this treatment is not causing more harm. Given that plus all the indications that it seems to help to some degree, we should be pursuing production scale of these drugs aggressively. It is very unfortunate that the media politicized this treatment in such a way that now everyone who dislikes Trump carries an initial bias against it.

starkd 7y ago
It's quite remarkable to see the media more focused on how they are supposed to oppose Trump rather than just reporting the news.
VBprogrammer 7y ago
To use a very celtic phrase, it's a shame Trump is such a gobshite he couldn't help himself but to promote this as a miracle cure before the science was settled.
orwin 7y ago
I'm not american and i really, really don't care about trump now (i did in 2017 when i wanted an internship in Ohio that was denied cause new policies and all that stuff but i eventually found something better, so i'm not angry about it). Antiviral drugs will always be given to late in this disease case, maybe it can reduce infectuosity but we don't know enough yet. Maybe giving it to everyone to prevent the disease before its even there could be helpfull, but if i had to take HCQ, i will have to stop taking my antihistamine drugs, and going into april/may, this is a big no for me. The fact that it can also reduce the autoimmune reaction is really interesting though, so maybe giving it to mild cases will prevent them to destroy their own cells, but this is also dangerous as the disease can cause myocard lesions (probably the autoimmune reaction, but we don't know yet). In any case, talking about it is useless before more data arrive: even if we could give HCQ to everybody, the lockdown is still necessary until the first wave decrease (at least in France). Don't forge an opinion on something this early, it will be hard to let it go if you're wrong, and being right early don't give you anything.

fb1994 7y ago

Check this out from an authority on viruses and bacteria .author of 23 books https://www.stephenharrodbuhner.com/wp-content/uploads/2020/03/coronavirus.txt.pdf https://www.stephenharrodbuhner.com/wp-content/uploads/2020/...

tangue 7y ago

I live in an island where during a viral outbreak some were advocating for chloroquine against the Chikungunya virus. The initial in-vitro tests were promising but it turns out during human trials it has a reverse effect and delayed adaptive immune responses (1). It's sad to see scientific method destroyed by politics and social networks. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977261/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977261/

Alex3917 7y ago
> It's sad to see scientific method destroyed by politics and social networks. If there were such a thing as phase 5 trials with at least a million participants, it would be completely insane to use anything that had only undergone phase 3 clinical trials. People should make rational decisions based on the best evidence that's available at the time. Whether or not it's rational to take HCQ, there's nothing magical about phase 3 studies. Antiviral drugs only really work in the first couple days of the illness, and with this disease you usually don't get symptoms until at least day 5. And in the current environment, no one is getting put on prescription antivirals until at least day 10, and usually even later. To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now.
- James_Henry 7y ago
  >To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now. I don't think I understand this. We have a clinical trial with in vivo data right here though, right?
  - Alex3917 7y ago
    > We have a clinical trial with in vivo data right here though, right? AFAIK there's no clinical trial data, but there is in vivo data. My point though is that these are drugs that block viral replication, and we're mostly only administering them after the virus has already finished replicating. So in that scenario of course it's going to look ineffective regardless of whether it actually works or not. I don't believe the data showing it works, but I also don't believe the data showing it doesn't work.

aazaa 7y ago

It's worth noting that this study does not include azithromycin in the treatment regime, as was the case in the Raoult/French study. The French study, problematic in the extreme but still promising, claims a large synergistic effect of using both drugs in combination. Also, unlike the French study, this one appears to be at least controlled, but possibly not blinded.

kiloDalton 7y ago
I think this counts a double blind trial. From the top of page 4 in the article: "Randomization was performed through a computer-generated list stratified by site. Treatments were assigned after confirming the correctness of the admission criteria. Neither the research performers nor the patients were aware of the treatment assignments."

wavepruner 7y ago

"Key findings: For the 62 COVID-19 patients, 46.8% (29 of 62) were male and 53.2% (33 of 62) were female, the mean age was 44.7 (15.3) years. No difference in the age and sex distribution between the control group and the HCQ group. But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia."